I had DCIS, lumpectomy and rads in 2008. In 2011 I had tissue expanders and exchange after six months of painful expansion. Six weeks later the wound opened on the cancer breast and I had implants removed. Over one year later, and after a total of four and a half post rads, and the breast has shrunk more and also develped spider veins/ugly red spots at the tumor spot. Can fat grafting fill in the divot and is there a higher risk of recurrence in DCIS patients?
Can Fat Grafting Be Safely Performed in DCIS After Lumpectomy and Radiation?
Doctor Answers 6
Fat grafting after lumpectomy
I'm going to be the odd plastic surgeon out here.
Fat grafting after lumpectomy is controversial and I won't do it until the science is more settled. There have been some good clinical studies out of Europe following patients who have had fat grafting to lumpectomy defects with no major issues BUT recent laboratory studies have suggested that the fat derived stem cells can make human breast cancer cells bigger and more likely to spread in animal models. These lab studies may eventually prove to red herrings but, for the moment, I caution my lumpectomy patients against fat grafting.
Can fat grafting be safely performed in DCIS after lumpectomy and radiation?
At our Breast Reconstruction Center, we have utilizing this technique almost routinely to maximize the aesthetic outcomes after lumpectomy or mastectomy. We have utilized the micro-fat grafting technique, and have been obtaining maximal fat graft survival into the breast. After harvesting of the fat from areas with excess fat, usually the belly, hips, or thighs, the fat is processed and injected back into the breast using the aforementioned techniques. Our patients have been very happy with the results as well as the areas where the liposuction was performed. Contour has been much improved using the micro-fat grafting technique, and the downtime is minimal.
Fat grafting has become a mainstay in breast reconstruction and has added another edge to breast reconstruction for aesthetics with minimal morbidity and complications.
Fat grafting after Lumpectomy?
Yes fat grafting can be safely done after lumpectomy and radiation. It should be done in small increments and allow enough time (at least 4 months). The blood supply is the key to successful fat grafting.
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Fat grafting is safe
Thank you for your question. I'm sorry for your trouble. I know that it is very frustrating to go through cancer treatment and then have complications. Fat grafting can be used in the treatment of postlumpectomy defects. The latest literature has shown that imaging can distinguish injected fat from breast tissue. This needs to be done by an experienced Board Certified plastic surgeon. If too much fat is injected, it can lead to fat necrosis and palpable nodules. The inherent problems with fat injection in this scenario are that the radiation diminishes the elasticity and ability of the overlying skin to stretch. In some patients the fat is not "strong enough" to push the skin back out. Sometimes we couple mobilizing the adjacent breast tissue along with the injection of fat to fill these defects. These are tricky though. Best of Luck!
Fat Grafting following lumpectomy and radiation
Typically, fat grafting can be utilized to add volume in resulting concavities following a lumpectomy or mastectomy. This being said, sometimes following radiation sequaele can be left for the patient to deal with such as skin pigmentation, altered skin elasticity, altered vascularity, and fat necrosis resulting in asymmetry and dissatisfaction to be dealt with. The skin has a decreased blood supply and therefore you might retain less of the fat that is being placed. Typically the fat is put in contact with healthy tissue with the premise to create its own blood supply. With a potential alteration in vascularity, the fat retention could be diminished as well. You could possibly require serial sessions of fat grafting which would be determined during your consultation. It is an outpatient surgery with minimal down time, therefore patients typically do not have a problem with this. It is important to set up a consultation with a Board Certified Plasic Surgeon who specializes in breast surgery and is well versed with latest advancements of the fat grafting technique.
I hope this helps you and good luck
Fadi Chahin MD, FACS
Plastic and Reconstructive Surgery
Diplomat, American Board of Surgery
Diplomat, American Board of Plastic Surgery
Can fat grafting be done in lumpectomy defects after radiation treatment.
Fat grafting is a valuable tool in breast surgery. This technique has gained more popularity over the past 7 years. There are many techniques used to harvest the fat, process the fat and then re-inject the fat. Conventional suction lipectomy is performed with a small diameter cannula, processed by separating the liquid and fibrous tissue from the fat, and then placed into syringes for re-injection or through a closed system.
Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!
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